IMPACT OF TWO INDEPENDENT STRATEGIES TO PROMOTE DOWNSTAGING IN BRAZIL

Transcription

1 THE ROLE OF EARLY DETECTION IN IMPROVING TREATMENT OUTCOMES FOR BREAST CANCER PATIENTS IN LMICS IMPACT OF TWO INDEPENDENT STRATEGIES TO PROMOTE DOWNSTAGING IN BRAZIL MAIRA CALEFFI, MD, PH.D CHIEF OF BREAST CENTER AT HOSPITAL MOINHOS DE VENTO PORTO ALEGRE, BRAZIL VOLUNTEER PRESIDENT OF FEMAMA UICC BOARD MEMBER

2 STRATEGY 1 Núcleo Mama Porto Alegre (NMPA) u A Private Public Partnership with the support of a IMAMA NGO; u 9,218 women above 15 years-old from a specific area in Porto Alegre; u Accrual from March 2004 to March 2006; u Asymptomatic years-old women entered the annual clinical examination and mammographic screening cohort; u Women out of this age range did their routine exams in the primary health care facilities. In case of any breast complaint, they were referred immediately to NMPA.

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4 PATIENT S JOURNEY 35 DAYS PHCF 7 DAYS CHEMO NMPA SURGERY ZERO 21 DAYS BIOPSY MMG 14 DAYS

5 CHARACTERISTICS OF THE COHORT PARTICIPANTS REGARDING MODE OF BREAST CANCER DETECTION Characteris*cs Mode of detec*on Screen- detected (n=50) N (%) Not screen detected (n=40) N (%) p- value** Age of menarche* 12.8 (1.7) 13,2 (2.1) 0.27 Body mass index (kg/m 2 )* 30.4 (6.3) 28.7 (6.4) 0.23 Number of pregnancies* 3.7 (2.7) 4.0 (3.1) 0.63 Age (years)* 58.4 (9.4) 55.0 (14.7) 0.20 Age (years) 59 ( 12.5) 55 (24.8) Age range (years) < (20.0) (22.0) 6 (15.0) (68.0) 17 (42.5) 70 5 (10.0) 9 (22.5) <0.05 Years of study Iliterate 5 (10.0) 3 (7.5) 1 to 8 years 33 (66.0) 29 (72.5) 9 years or more 11(22.0) 8 (20.0) Not informed 1 (2,0) 0, Smoking Ex- smoking 4 (8.7) 0 Non smoking 31 (67.4) 20(58.8) Current smoking 11 (23.9) 14 (41.2) 0.09

6 PARTICIPATION RATE OF WOMEN IN MAMMOGRAPHIC SCREENING IN 18 MONTHS, ACCORDING TO AGE - NMPOA

7 PATHOLOGIC FEATURES OF SCREEN-DETECTED AND NOT SCREEN DETECT BREAST CARCINOMAS Characteris*cs Mode of detec*on Screen- detected (N=50) N (%) Not screen detected (N=40) N (%) p Tumor size (mm)* 16.7 (10.0) 18.5 (15.4) 0.54 Tumor size (mm) 15.0 (10.0) 15.5 (17.5) Tumor size categories < 20 mm 28 (65.1) 23 ( 63.9) >20-50 mm 14 (32.6) 6 (30.6) >50 mm 1 (2.3) 2(5.6) 0.75 Tumor type IDC 38 (80.0) 32 (77.5) ILC 2 (2.0) 1 (5.0) Mixed 3 (4.0) 0 (2.5) Other 2 (2.0) 1 (5.0) DCIS 4 (12.0) 6 (10,0) 0.54 Stage** I 21 (47.7) 13 (38.2) II 19 (43.2) 14 (41.2) III 4 (9.1) 6 (17.6) IV 1 (2.9) Grade** Grade 1 10 (29.4) 2 (8.0) Grade 2 19 (55.9) 13 (52.0) Grade 3 5 (14.7) 10 (40.0) 0.03

8 Official data (2011): u 10% STAGE I AND 53% STAGE III AND IV u 51.3% of cancer patients had their 1 st treatment between 60 and 120 days. Cohort Nucleo Mama Porto Alegre Data (2014): u According to our research, 43% of the patients were STAGE I and 15% of patients were STAGE III and IV. u The tumor size was not statistically different among the two studied groups (screened and not screened) u The average time to 1 st treatment in our cohort was 21 days.

9 FINDINGS u Based on the NMPA prospected study, we can infer that: (1) an efficient health care system with well trained and committed u Based on the NMPA prospected study, we can infer that: (1) health care an physicians efficient professionals health awareness and care (2) system may intensive be with as community good well trained as annual and and primary screening committed mammography to promote breast cancer changes in public policies in order to achieve cancer control. in LMICs.

10 National coalition of 58 patients groups in 17 States in Brazil. Founded in 2008.

11 CIVIL SOCIETY S ROLE TOWARDS BREAST CANCER SURVIVAL IMPROVEMENT DUE TO EARLY DETECTION FEMAMA S ACHIEVEMENTS SINCE % of mammography coverage Law of Mammography after 40 years-old #11.664/ % certification for providers of SUS services and supplementary March 23, National Program for Quality in Mammography INCA March 23, Cervical and Breast Cancer Control National Plan May 23, days maximum time between 1st consultation and treatment initiation Law # Period of 60 days to start cancer treatment after diagnosis (pathological report)

12 PATIENT S PATH

13 30 days LAW PROJECT # for PL exams 5722/13 when cancer is suspected indicated by the physician # PL 5722/13 approval of the Law of 30 days during the Pink October 2013; u Participation in 2 Public Audiences with request to approve the Law of 30 days in House of Representatives; u Request for Congressman to vote urgently the Law of 30 days; u Institutional events held manifestation of agreement with the Law of 30 days: 2) 1) Forum National to Congress Fight Cancer All Together Woman Against Cancer 2) Forum to Fight Cancer Woman

14 ADVOCACY CAMPAIGN #OTEMPOCORRECONTRA #TIMERUNSAGAINST Hot Site Folders Banners

15 ADVOCACY CASE: LOBBY DAY

16 THANK YOU! Maira Caleffi, MD, Ph.D Chief of Breast Center at Hospital Moinhos de Vento Volunteer President of FEMAMA UICC Board Member